N. Ben Mami

La Rabta Hospital Tunis, Tunis-Ville, Tūnis, Tunisia

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Publications (107)27.18 Total impact

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    ABSTRACT: Introduction The ophthalmic complications following interferon therapy in chronic hepatitis C are rare. The most common adverse ophthalmic outcome is the dysoric retinopathy characterized by the presence at the fundus examination of cotton wool spots and retinal hemorrhages particularly around the optic disc. Case report A 63-year-old man presented to the hepatology department with a compensated cirrhosis C. His medical history was positive for hypertension controlled by medical treatment. A combined treatment with pegylated interferon α2a plus ribavirin was initiated. Three months later, the patient reported a sudden decreased vision in both eyes. Fundus examination revealed cotton wool spots with retinal hemorrhage. The diagnosis of dysoric retinopathy was established. The antiviral treatment was discontinued. One month later, the patient was asymptomatic and the ocular lesions have disappeared. Conclusion Dysoric retinopathy is a non-specific complication of interferon therapy in chronic hepatitis C. Despite its good prognosis, a careful fundus examination is required before and during the treatment especially for the patients with risk factors for this adverse event (advanced age, diabetes and high blood pressure).
    La Revue de Médecine Interne. 08/2014; 35(8):543–545.
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    ABSTRACT: Hepatitis C virus (HCV) protease inhibitors (PIs) and polymerase inhibitors: nucleos(t)ide inhibitors (NS5B-NIs) and non-nucleos(t)ide inhibitors (NS5B-NNIs) have been recently developed to inhibit protease (NS3) or polymerase (NS5B) activities. The drawback of antiviral treatment is the emergence of resistance mutations to the drugs. The prevalence of such mutations conferring resistance to PIs, NS5B-NIs, and NS5B-NNIs before treatment has not been investigated so far in the Tunisian population. The aim of this study was to investigate the prevalence of known substitutions conferring resistance to HCV-PIs, NS5B-NIs, and NS5B-NNIs in 149 untreated patients naïve of any novel or investigational anti-HCV drugs and infected with HCV genotype 1 (genotype 1a = 7; genotype 1b = 142). Twelve sequences (9.2%) of the 131/149 HCV NS3 sequences analyzed showed amino-acid substitutions associated with HCV PIs resistance mutations (T54S, n = 4 (3%); V55A, n = 2 (1.5%); Q80K, n = 4 (3%); R155K, n = 1 (0.7%); A156V, n = 1 (0.7%)). One (1%) of the 95/149 HCV NS5B sequences analyzed showed the substitution V321I conferring resistance to NS5B-NIs, while 34 of 95 (35.8%) showed substitutions conferring resistance to NS5B-NNIs (C316N, n = 2 (2%); M414L, n = 1 (1%); A421V, n = 8 (8.5%); M423A, n = 1 (1%); M423T, n = 2 (2%); I424V, n = 5 (5.2%); C445F, n = 1 (1%); I482T, n = 2 (2%); V494A, n = 1 (1%); P496A, n = 1 (1%); V499A, n = 15 (16%); S556G, n = 5 (5.2%)). Naturally occurring substitutions conferring resistance to NS3 or NS5B inhibitors exist in a substantial proportion of Tunisian treatment-naïve patients infected with HCV genotype 1. Their influence on treatment outcome should be assessed. J. Med. Virol. © 2014 Wiley Periodicals, Inc.
    Journal of Medical Virology 04/2014; · 2.37 Impact Factor
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    ABSTRACT: The ophthalmic complications following interferon therapy in chronic hepatitis C are rare. The most common adverse ophthalmic outcome is the dysoric retinopathy characterized by the presence at the fundus examination of cotton wool spots and retinal hemorrhages particularly around the optic disc. A 63-year-old man presented to the hepatology department with a compensated cirrhosis C. His medical history was positive for hypertension controlled by medical treatment. A combined treatment with pegylated interferon α2a plus ribavirin was initiated. Three months later, the patient reported a sudden decreased vision in both eyes. Fundus examination revealed cotton wool spots with retinal hemorrhage. The diagnosis of dysoric retinopathy was established. The antiviral treatment was discontinued. One month later, the patient was asymptomatic and the ocular lesions have disappeared. Dysoric retinopathy is a non-specific complication of interferon therapy in chronic hepatitis C. Despite its good prognosis, a careful fundus examination is required before and during the treatment especially for the patients with risk factors for this adverse event (advanced age, diabetes and high blood pressure).
    La Revue de Médecine Interne 10/2013; · 0.90 Impact Factor
  • La Tunisie médicale 06/2013; 91(6):420-1.
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    ABSTRACT: Introduction The laparoscopic approach is becoming the gold standard in the surgical treatment of primary Crohn's disease. The aim of this study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease. Methods We conducted a non-randomized, comparative, retrospective analysis of a prospective database from 1998 to 2010. The remaining 129 patients were divided into two groups: laparoscopic-assisted group (Group L; n = 64) and conventional group (Group C; n = 65). There were no differences between the two groups as regards preoperative patient characteristics. Complications were graded according to the Clavien-Dindo classification. Results One hundred and seventeen (90.7%) patients had no complications. Out of 12 patients (9.3%) with complications, four (3.1%) had Grade I, six (4.7%) had Grade II and two (1,6%) had Grade III. There were no postoperative deaths (Grade V). Operating time was longer in Group L compared to Group C (P < 0.001). Bowel function returned more quickly in the laparoscopic group in terms of return of bowel movements (P = 0.018) and resumption of a regular diet (P = 0.06). The mean length of stay was significantly shorter in the laparoscopic group (P = 0.001). The mean follow-up was 26 months in Group L versus 34 months in Group C (P = 0.06). During follow-up, six patients presented with small bowel obstruction in Group C, which was not statistically different from Group L (3 patients) (P = 0.25). During the follow-up period, there have been no recurrences of Crohn's disease in the laparoscopic group while 11 patients (16.9%) have developed a recurrence in the conventional group (P = 0.001). Conclusion Laparoscopic-assisted ileocolectomy for primary Crohn's disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn's disease should be considered as the preferred operative approach for primary resections.
    Journal de Chirurgie Viscérale. 04/2013; 150(2):154–160.
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    ABSTRACT: Hepatitis B virus (HBV) infection is a public health problem in developing countries. HBV genotypes play major role in the evolution of infection since they were involved in different clinical presentations and response to treatment. This study was conducted to evaluate the efficiency of restriction fragment length polymorphism (RFLP) analysis for HBV genotyping. We investigated 98 samples collected from patients chronically infected with HBV. HBV genotypes were determined by analysis of patterns obtained after amplification in Pre-S region and digestion of the amplicon by two endonucleases AvaII and DpnII. Obtained results were confirmed by partial sequencing in the same region. Two different HBV genotypes were detected in this study, Genotype D (in 95. 9%) and Genotype A (in 4.1%). Seventy-four samples (75.5%) were successfully genotyped with RFLP analysis and all classified as genotype D. The remaining 24 samples (24.5%) which were un-genotyped by RFLP analysis, were classified by partial sequencing of the pre-S region as HBV genotype D (20 samples, 20.4%) and genotype A (4 samples, 4.1%). Atypical profiles were significantly associated with advanced liver disease (P = 0.001) as well as older age (P < 0.05). Several previous studies used PCR-RFLP to genotype HBV; however, we showed the high risk to obtain atypical profiles, especially in advanced stages of chronic infection, with as results difficulties to genotype the virus. These profiles resulted from the accumulation of mutations during natural course of infection resulting in a modification in restriction sites for enzymes. So, we recommended completing the investigation by partial sequencing to confirm obtained results.
    Hepatitis Monthly 01/2013; 13(10):e11781. · 1.25 Impact Factor
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    ABSTRACT: Genetic variability of hepatitis B virus (HBV) in the C gene and its association with the different stages of chronic liver disease has been studied inadequately with controversial results. The objectives of the current study were to determine the frequency of core promoter and precore mutations in chronic hepatitis B in Tunisia and to evaluate their impact on viral replication and disease progression. Sequencing was performed in upstream regulatory sequence (URS), pre-core (PreC) and basal core promoter (BCP) regions for 123 chronic infected patients by HBV genotype D at different status of disease. Mutations were detected in 98.4% of cases, affecting URS, BCP and Pre-C in 95.1%, 95.9% and 87.8% respectively. Multi-mutations increased significantly from asymptomatic carrier to advanced liver disease status. G1896A (74.8%), G1764A/T/C (71.5%), G1899A (54.4%) and T1678C (52%) were the most common. Special attention should be paid to A1703T, T1678C/G-A1703T, and A1652G-A1679G mutations probably specific of Tunisians sequences; they were observed in 40.6%, 41.5% and 30.1% respectively. A1679G/C, T1753C/G/A, A1762T/G and A1762T-G1764A were more prevalent in older patients. High DNA levels were associated with G1899A or G1764T/C-C1766G-C1799G and advanced liver disease with mutations at positions 1762, 1764 and/or 1899 alone or in double or triple mutations. It was also shown that substitutions at nucleotides 1762, 1764 and 1899 have an impact on the disease progression. It is the first report for specific mutations in the URS region for genotype D. It should be completed by studying eventual correlation with clinical progression and the response to treatment. J. Med. Virol. 84:1719-1726, 2012. © 2012 Wiley Periodicals, Inc.
    Journal of Medical Virology 11/2012; 84(11):1719-26. · 2.37 Impact Factor
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    ABSTRACT: INTRODUCTION: The laparoscopic approach is becoming the gold standard in the surgical treatment of primary Crohn's disease. The aim of this study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease. METHODS: We conducted a non-randomized, comparative, retrospective analysis of a prospective database from 1998 to 2010. The remaining 129 patients were divided into two groups: laparoscopic-assisted group (Group L; n=64) and conventional group (Group C; n=65). There were no differences between the two groups as regards preoperative patient characteristics. Complications were graded according to the Clavien-Dindo classification. RESULTS: One hundred and seventeen (90.7%) patients had no complications. Out of 12 patients (9.3%) with complications, four (3.1%) had Grade I, six (4.7%) had Grade II and two (1.6%) had Grade III. There were no postoperative deaths (Grade V). Operating time was longer in Group L compared with Group C (P<0.001). Bowel function returned more quickly in the laparoscopic group in terms of return of bowel movements (P=0.018) and resumption of a regular diet (P=0.06). The mean length of stay was significantly shorter in the laparoscopic group (P=0.001). The mean follow-up was 26months in Group L versus 34months in Group C (P=0.06). During follow-up, six patients presented with small bowel obstruction in Group C, which was not statistically different from Group L (3 patients) (P=0.25). During the follow-up period, there have been no recurrences of Crohn's disease in the laparoscopic group while 11 patients (16.9%) have developed a recurrence in the conventional group (P=0.001). CONCLUSION: Laparoscopic-assisted ileocolectomy for primary Crohn's disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn's disease should be considered as the preferred operative approach for primary resections.
    Journal of Visceral Surgery 10/2012; · 1.17 Impact Factor
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    ABSTRACT: PurposeEosinophilic gastroenteritis is a rare and heterogeneous disorder characterized by eosinophilic infiltration of one or more layers of the gastrointestinal tract. Although it can involve any part of the gastrointestinal tract, the stomach and the proximal small bowel are the most common sites of involvement. Clinical features depend on which layer and site are involved. We report eight cases of eosinophilic gastroenteritis.Methods We conducted a retrospective review of consecutive adult cases diagnosed with eosinophilic gastroenteritis from 1990 to 2010. The diagnosis was established by histologic examination of endoscopic biopsy or operative specimen or by the presence of eosinophilic ascites.ResultsEight patients (three men, five women) were diagnosed with eosinophilic gastroenteritis during the study period. Three out of the eight patients had a history of allergy. All patients had gastrointestinal symptoms. The most common symptoms were abdominal pain, vomiting, weight loss and ascites. Seven patients (87.5%) had hypereosinophilia. Seven patients had involvement of the subserosa and one of the mucosa. Four patients were treated with oral prednisolone. The symptoms in all the patients subsided within one month. The remaining four patients improved spontaneously. Four of our patients were followed-up for at least 2 months (11 to 68 months). A single patient presented a relapse.Conclusion Eosinophilic gastroenteritis should be suspected in patients having gastrointestinal discomfort along with peripheral eosinophilia. Definitive diagnosis requires histological demonstrations of eosinophilic infiltration of the gastrointestinal wall or high eosinophilic count in ascites fluid.
    La Revue de Médecine Interne. 08/2012; 33(8):421–425.
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    ABSTRACT: Eosinophilic gastroenteritis is a rare and heterogeneous disorder characterized by eosinophilic infiltration of one or more layers of the gastrointestinal tract. Although it can involve any part of the gastrointestinal tract, the stomach and the proximal small bowel are the most common sites of involvement. Clinical features depend on which layer and site are involved. We report eight cases of eosinophilic gastroenteritis. We conducted a retrospective review of consecutive adult cases diagnosed with eosinophilic gastroenteritis from 1990 to 2010. The diagnosis was established by histologic examination of endoscopic biopsy or operative specimen or by the presence of eosinophilic ascites. Eight patients (three men, five women) were diagnosed with eosinophilic gastroenteritis during the study period. Three out of the eight patients had a history of allergy. All patients had gastrointestinal symptoms. The most common symptoms were abdominal pain, vomiting, weight loss and ascites. Seven patients (87.5%) had hypereosinophilia. Seven patients had involvement of the subserosa and one of the mucosa. Four patients were treated with oral prednisolone. The symptoms in all the patients subsided within one month. The remaining four patients improved spontaneously. Four of our patients were followed-up for at least 2 months (11 to 68 months). A single patient presented a relapse. Eosinophilic gastroenteritis should be suspected in patients having gastrointestinal discomfort along with peripheral eosinophilia. Definitive diagnosis requires histological demonstrations of eosinophilic infiltration of the gastrointestinal wall or high eosinophilic count in ascites fluid.
    La Revue de Médecine Interne 05/2012; 33(8):421-5. · 0.90 Impact Factor
  • La Tunisie médicale 04/2011; 89(4):403-5.
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    ABSTRACT: IntroductionLe kyste hydatique est une affection parasitaire, endémique en Tunisie, secondaire au développement de la larve d’Echinococcus granulosus dans l’organisme. Le kyste hydatique se localise essentiellement au niveau du foie où certaines complications peuvent se développer. Les complications vasculaires secondaires au kyste hydatique à type de syndrome de Budd-Chiari (SBC) ont été rarement rapportées. ObservationsNous rapportons trois cas de SBC secondaire à un kyste hydatique du foie (KHF). Le kyste occupait au moins deux segments du dôme hépatique dans tous les cas. Le diamètre du kyste était respectivement de 12,5, 21 et 12,5 cm. Le kyste était de type III dans un cas et de type IV dans les deux autres, selon la classification de Gharbi. Le SBC était chronique dans un cas et asymptomatique dans les deux autres. Son diagnostic a été retenu par l’échographie abdominale dans deux cas, complétée par une étude doppler et par un angioscanner chez un malade et par un angioscanner chez l’autre. Chez la troisième patiente, le diagnostic du SBC a été retenu sur les données de l’angioscanner uniquement. Le SBC était dû à la compression de deux veines hépatiques (VH) [n = 1], de la veine cave inférieure (VCI) [n = 1] et d’une veine hépatique et de la VCI dans le dernier cas. Une laparotomie a été pratiquée dans les trois cas. Le geste chirurgical a consisté en une résection du dôme saillant précédé par une ponction-aspiration du contenu kystique chez tous les patients. Une malade a présenté en postopératoire des collections profondes au niveau de la cavité résiduelle, nécessitant un drainage, ainsi qu’une ascite. ConclusionLe kyste hydatique doit être évoqué en cas de SBC dans les pays endémiques pour cette parasitose. Inversement, cette complication vasculaire devrait être systématiquement recherchée en cas de kyste hydatique du foie. IntroductionHydatid disease is a parasitic infestation due to the development of Echinococcus granulosus in the organism. This disease is particularly frequent in Tunisia where echinococcosis is endemic. Liver is the most common organ to be affected by hydatidosis, and several complications have been described. Vascular complications secondary to hepatic echinococcosis such as Budd-Chiari syndrome have rarely been reported. Case reportsWe report three rare cases of hydatid cyst complicated by Budd-Chiari syndrome. The cyst occupied at least two segments of the hepatic dome in all patients, and its diameter was 12.5, 21 and 12.5 cm, respectively. According to the Gharbi classification, the cysts were type III in one case and type IV in the other two cases. The Budd-Chiari syndrome was chronic in one patient and asymptomatic in other cases. The diagnosis was established by abdominal ultrasound (US) in two cases, confirmed by Doppler US and CT angiogram in one patient and by CT angiogram in the other. The diagnosis was established only by CT angiogram in the third case. The Budd-Chiari syndrome was due to the compression of two hepatic veins in one case, compression of inferior vena cava in one case and compression of one hepatic vein and inferior vena cava in another case. Laparotomy was performed in all patients. The surgical procedure comprised the resection of the protruding hepatic tissue after puncture aspiration of the cyst in all the three cases. The postoperative period was complicated by abscess formation in residual cavity, requiring drainage, and by the development of ascites in one case. ConclusionHydatid cyst should be suspected amongst the causes of Budd-Chiari syndrome in countries where the disease is endemic. Conversely, this vascular complication should be looked for routinely in patients with hydatid disease of the liver. Mots clésKyste hydatique du foie–Syndrome de Budd-Chiari KeywordsHepatic echinococcosis–Budd-Chiari syndrome
    Journal Africain d?Hépato-Gastroentérologie 01/2011; 5(3):193-197.
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    ABSTRACT: La lymphangite carcinomateuse (LC) duodénale a été décrite de façon sporadique. Nous rapportons un nouveau cas de LC duodénale. La fibroscopie œsogastroduodénale objectivait un épaississement des plis de Kerckerning bulbaires dont la surface prenait un aspect ponctué, granuleux et rougeâtre. Le reste de la muqueuse gastrique et duodénale était normal. Devant cet aspect granuleux, une étiologie inflammatoire ou néoplasique, et en premier lieu un lymphome, a été évoquée. L’étude anatomopathologique des biopsies réalisées au niveau de la lésion montrait une muqueuse duodénale d’aspect normal avec présence dans la partie haute de la lamina propria de vaisseaux lymphatiques dilatés renfermant des cellules néoplasiques agrégées. Celles-ci n’ont pas été retrouvées dans le tissu extralymphatique de la lamina propria et de la sous-muqueuse. C’est cette dilatation des vaisseaux lymphatiques qui semblait à l’origine de cet aspect granuleux. La tumeur primitive était endométriale. La patiente est décédée 70 jours après le diagnostic. Duodenal lymphangitis carcinomatosa has been described sporadically. We report a new case of lymphangitis carcinomatosa of the duodenum. The gastroscopy showed a thickening of the duodenal folds which appears to be punctate, grainy, and reddish. This grainy appearance seems to be secondary to an expansion of neoplastic cells in the lymphatic vessels. On pathological study, lesions were characterized by a normal mucosa with presence in the upper part of the lamina propria of dilated lymphatic vessels containing aggregated neoplastic cells. These aspects were not found in the extralymphatic tissues of the lamina propria and the submucosa. The primitive tumor was endometrial. The patient died 70 days after diagnosis. Mots clésDuodénum–Lymphangite–Cancer KeywordsDuodenum–Lymphangitis–Cancer
    Journal Africain d?Hépato-Gastroentérologie 01/2011; 5(1):57-59.
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    ABSTRACT: Résumé Les tumeurs carcinoïdes gastriques représentent une entité endoscopique rare. Nous rapportons le cas d’un patient présentant de multiples tumeurs carcinoïdes gastriques.
    Acta Endoscopica 01/2011; 41(1):37-38. · 0.16 Impact Factor
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    ABSTRACT: Autoimmune hepatitis (AIH) is a chronic inflammatory condition of the liver of unknown etiology. Its epidemiological and anatomoclinical characteristics and its outcome were unknown in Tunisia. To analyse epidemiological, anatomoclinical, immunological and histological aspects of AIH and to determine factors predicting relapse after treatment and death of this disease in Tunisia. Patients presenting with AIH between January 1996 and December 2004 were evaluated in retrospective multicentric study. The diagnosis of AIH was established according to the criteria of the revised score of the international autoimmune hepatitis group (1999) Eighty three patients were identified (70 female; mean age=49+17.9 years). 63% presented probable AIH and 37% presented definite AIH. Thirty two percent presented with the acute pattern. Eighty three per cent of cases were type I AIH and 5 % of cases were type II HAI. Fifty seven percent of the patients were cirrhotic at presentation. Associated autoimmune diseases was seen in 27 patients, dominated by diabetes, autoimmune thyroiditis and Sjögren's syndrome. An overlap syndrome was diagnosed in 25% of cases; primary biliary Cirrhosis-AIH in 20% of cases and primary sclerosing cholangitis-AIH in 5% of cases. Fifty patients were treated by glucocorticoids as monotherapy or in combination with azathioprine. Complete remission was achieved in 90% of cases. Fourteen percent relapsed within a median time of 12 months. Factors associated with relapse were: treatment with Azathioprine<18 months, absence of lobular necrosis and anti-nuclear antibody (+) profile. Mortality was observed in 17 % of cases. Factors associated with death were encephalopathy as an independent factor and treatment with Azathioprine<18 months. In Tunisia, epidemiological and clinical characteristics of AIH were similar to those reported in the literature but with a higher frequency of cirrhosis at presentation. Treatment with Azathioprine < 18 months was the main factor associated with relapse and represented with encephalopathy a factor associated with death.
    La Tunisie médicale 11/2010; 88(11):834-40.
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    ABSTRACT: Assessment of prognosis in patients with cirrhosis is important so as to plan their management. To determine the survival rates and to identify indicators associated with shorter life expectancy in Tunisians patients with cirrhosis. This is a retrospective study of in-patients with cirrhosis during a 5-years period. We studied clinical and biochemical characteristics of all patients and the occurrence of decompensation or complication. The overall survival, mortality rate and causes of death were reviewed. Univariate and multivariate analysis was performed on all variables to identify parameters associated with a lower life expectancy. We studied 222 patients (60% females) with a mean age of 60 years. Mean follow up was 22 months. The overall survival was 52.5% at 5 years. With univariate analysis, 10 variables were associated with a poor prognosis: male gender, decompensation at admission, Child-Pugh C, esophageal varices, hypertensive gastropathy, occurrence of spontaneous bacterial peritonitis, hepatic encephalopathy, hepato-renal syndrome, hepatocellular carcinoma and portal thrombosis. With multivariate analysis, only male gender was independently correlated with survival. In our study, male gender was an uncommon parameter that predicts survival in cirrhotic patient. The Child-Pugh score was a good index for assessing the prognosis.
    La Tunisie médicale 11/2010; 88(11):804-8.
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    ABSTRACT: Hepatitis C viral infection can be associated with other infectious diseases including viral and bacterial infections such as tuberculosis. Mycobacterium tuberculosis infection may be latent for many years and revealed during an immunodeficiency state. The responsibility of antiviral treatment in the reactivation of tuberculosis is controversial. We report two cases of tuberculous reactivation during bitherapy with pegylated interferon and ribavirin for chronic hepatitis C. A rapid viral response was obtained in both cases. Tuberculous reactivation occurred at 12 and 13 weeks of antiviral treatment, respectively. Tuberculosis involved urinary tract in one patient and lymph nodes in the other. Antituberculous treatment was given and antiviral treatment maintained. The outcome of tuberculosis was favourable and a sustained viral response was obtained for both patients.
    La Revue de Médecine Interne 11/2010; 31(11):e1-3. · 0.90 Impact Factor
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    ABSTRACT: Sarcoidosis is a granulomatous disorder of unknown cause, characterised by noncaseating granulomas affecting multiple organs. Gastrointestinal tract involvement in sarcoidosis is rare. The stomach, particularly the antrum is the most common extra-hepatic organ to be involved. We report four cases of gastro-intestinal sarcoidosis. Retrospective study of a series of four cases. All patients had gastric sarcoidosis. It involved the duodenum, ileum and gall bladder in a patient with a history of an acute pancreatitis probably due to sarcoidosis. This patient presented with obstructive intestinal manifestations, weight loss and exsudative enteropathy. Two patients presented with mild abdominal pain and the last patient was admitted for upper gastrointestinal bleeding. The endoscopy was normal in one case and showed an antral congestion in another case. Gastric ulcers were found in the patient with a history of upper gastro-intestinal bleeding. A pseudo-linitic aspect was noticed in the patient with obstructive manifestations. The duodenum and the ileum were normal. This patient had an antrectomy and was treated with corticosteroids. Surgery evidenced a perforated duodenal ulcer, which was obstructed by the gall bladder. The patient with gastrointestinal bleeding received proton pump inhibitor and corticosteroids. These two patients improved gradually. The two other patients recovered spontaneously. The stomach is the most commonly affected organ in gastrointestinal sarcoidosis. Gastric sarcoidosis can mimic a malignant lesion owing to narrowing of the gastric lumen or can be revealed by upper gastrointestinal bleeding. Duodenum, small bowel and colon involvement is uncommon but may be underestimated in the absence of systematic biopsies.
    La Revue de Médecine Interne 02/2010; 31(4):262-7. · 0.90 Impact Factor
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    ABSTRACT: The association of Budd-Chiari syndrome and celiac disease is rare and has been reported in only 13 cases. We report a 23-year-old man with celiac disease, treated with gluten-free diet since the age of 16 years. He presented with epigastric pain that was secondary to a Budd-Chiari syndrome. No other cause than celiac disease could be identified.
    La Revue de Médecine Interne 02/2010; 31(2):160-2. · 0.90 Impact Factor
  • Revue De Medecine Interne - REV MED INTERNE. 01/2010; 31.

Publication Stats

114 Citations
27.18 Total Impact Points

Institutions

  • 2010–2013
    • La Rabta Hospital Tunis
      Tunis-Ville, Tūnis, Tunisia
  • 2010–2012
    • Institut Pasteur de Tunis
      Tunis-Ville, Tūnis, Tunisia
  • 2009
    • Hopital Habib Thameur
      Tunis-Ville, Tūnis, Tunisia
  • 2004
    • Faculty of Medecine of Tunis
      Tunis-Ville, Tūnis, Tunisia